Kremezin (AST 120)

[AguynamedKim]

I thought I would open up a discussion of Kremezin (AST 120) - the drug, not the user.     He's go his intro thread here http://ihatedialysis.com/forum/index.php?topic=20283.0 which caused me to investigate this drug.  In summary, it is a form of adsorptive carbon.  It appears to absorb uremic toxins secreted in the digestive tract or produced in the intestinal tract and excretes then with faeces.  http://www.mt-pharma.co.jp/e/release/nr/mpc/2006/pdf/e061108.pdf  There's definitely research on the "delay dialysis" aspect of this drug but this thread http://ihatedialysis.com/forum/index.php?topic=20090.0 and a reply by Rightside "The neuropathy may be related to the buildup of Advanced Glycation End Products (AGEs) in the body of a dialysis patient.  (Those compounds are big molecules and not dialyzed out.)  I posted on that once before.  In Europe, they're experimenting with benfotiamine to reduce the AGE load in the body."  got me thinking that this might be investigated/effective for people at other/all stages of CKD.

Rightside, would you mind linking your post on AGEs?  I was looking for it but can't seem to find it.  I tried searching on AGE but I ended up with 86 pages of topic hits.

[natnnnat]

Oh yes I remember that discussion well, I went into overdrive that day!

http://ihatedialysis.com/forum/index.php?topic=19320.msg328525#msg328525

enjoy dear sir.

[AguynamedKim]

Thank you very much, natnnnat!  I guess I know what my homework is going to be tonight - find a way to smuggle in AST 120.  It's got to be easier than reading through all these studies and figuring out what to do!   

I was a genetic oncology researcher in college (degree in Biology) so I'm all too familiar with reading through research papers.  There's a reason I did not stick with being a researcher.   

While I say that, this site has taught me that information is king, and a ounce of prevention is worth a pound of cure (.45 kilos for all my freinds who are on a real measurement system) so I look forward to wading through as best I can.

[greg10]

Diabetics also have unusally high levels of AGEs.  Interesting that there is a high correlation between diabetes and CKD.
"A company called VeraLight has developed an innovative screening tool for Type II diabetes. Called the Scout, it employs fluorescence spectroscopy to non-invasively measure biomarkers in the top layer of skin of a subject's forearm. Unusually high concentrations of this important biomarker, advanced glycation endproducts (AGEs), are indicative of diabetes."
http://www.sciencedaily.com/videos/2007/1104-detecting_diabetes_with_light.htm

[AguynamedKim]

Looks like they just completed a study all over the world about using Kremezin "A Study of AST-120 for Evaluating Prevention of Progression In Chronic Kidney Disease (EPPIC-1)".  It was scheduled to complete January of 2011.  Hopefully we'll hear positive results soon and this will be available oustide of Japan, Korea and I believe the Phillipines. 

http://www.clinicaltrials.gov/ct2/show/NCT00500682?term=Kidney&rank=36

[AguynamedKim]

Looks like they extended the trial through to October 2011.  That's generally a good thing with clinical trials, e.g. we had positive initial results so we extended the trial to collect more data.  Hopefully they will publish results soon.

[AguynamedKim]

The study I linked still hasn't posted results. 

I did, however, find this study linked below which sites the ability of AST-120 to "decrease protein-bound solute concentration".  This could provide benefit not just for pre-dialysis but also dialysis patients to help remove "protein-bound compounds" which are difficult to remove through dialysis (especially those who do not get the benefits of long, slow dialysis).  An example of these compounds:

•Indoxyl sulfate: declines renal function, thyroid function, protein binding of drugs, detoxification, and endothelial function and repair; induces oxidative stress, osteoblast resistance to PTH, smooth muscle cell proliferation, and aortic calcification   

If this inexpensive drug can help reduce these toxins, I sure hope it's made widely available soon.  I know I would love to see it help my friends here.

http://www.jrnjournal.org/article/S1051-2276(11)00216-0/abstract

[Whamo]

This sounds promising.   

[cassandra]

Promising indeed, however if it is inexpensive, it might be really difficult to actually get it to patients, as the consequence could be less money for the pharmaceutical industry who are benefitting from the status quo?

take care Cas

[AguynamedKim]

I came across this older article regarding Kremezin that showed that taking Kremzin AST-120 helped delay dialysis. http://www.renalandurologynews.com/oral-adsorbents-probiotics-an-inexpensive-way-to-eliminate-uremic-toxics-in-ckd-patients/article/234866/#

"AST-120 is an oral adsorbent that has been studied in rats and humans. In a Japanese study with CKD patients, AST-120 was compared with standard care. The dialysis-initiation-free rate was significantly higher in the AST-120 group compared with the non-AST-120 group at 12 and 24 months (25% and 13.7%, respectively vs. 10.5% and 5.7%, respectively). However, this improved rate did not translate into improved survival rates in the AST-120 group (Int J Nephrol 2012; published online ahead of print. Curr Med Res Opin. 2009;25:1913-1918)."

*1/28/13 - AGuyNamedKim - Fixed Link